Poller (blocking) screws play a crucial role in complex fracture fixation. This blog explores their evolution, from first to third-generation techniques, discussing optimal placement, biomechanics, and their impact on stability, reduction, and healing time.
Fine wire frame fixation offers a unique approach to managing complex limb injuries, providing enhanced stability and promoting weight-bearing. This guide explores key principles, indications, and challenges of this technique.
Following resection of the distal tibia and talus due to chronic osteomyelitis, bone transport using a fine wire frame was performed. However, misalignment at the docking site became evident only after frame removal. A review of similar cases suggests that the commonly used “dynamisation” period may not be a reliable test for confirming bony healing.
After 27 months, the fracture has clinically united. The patient successfully removed connectors between the second and third ring and can walk without additional pain. The next step is frame removal, followed by discussions on removing cement remnants and applying bone graft.
Patient’s activity level continues to improve, still using crutches for mobility. Pin sites remain stable. The frame has been dynamised to allow vertical movement, with a review scheduled in four weeks to assess alignment.
The CT scan revealed additional callus formation, but full union has yet to be achieved. Struts were replaced with threaded bars and hinges to improve stability and correct valgus deformity. Weight-bearing will continue as tolerated, with a follow-up scheduled in one week.
The patient continues using crutches but manages shorter distances unaided. No changes in leg alignment, with valgus remaining at 10-14 degrees. X-rays indicate further fracture healing and mature regenerate. A discrepancy in fibula movement is noted, but no ankle instability or pain is present. A CT scan is requested for further evaluation.
The patient can now walk unaided for short distances. A minor pin site infection emerged but resolved with conservative treatment. X-rays suggest continued fracture union, though a slight valgus shift is noted. A follow-up is scheduled to assess progress and consider a CT scan for confirmation.
The patient is now walking with a stick, with knee pain remaining the primary concern. Pin sites are stable, and clinical progress toward union is promising. X-rays indicate satisfactory bone regeneration, but confirmation of proximal fracture healing is needed before frame removal.
The patient is now walking with a stick, with knee pain remaining the primary concern. Pin sites are stable, and clinical progress toward union is promising. X-rays indicate satisfactory bone regeneration, but confirmation of proximal fracture healing is needed before frame removal.
